Active NPI
Christopher Daniel Pesut, DMD
- Periodontics
- Tucker, GA
National Provider Identifier
1902352149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN123392
- Practice address
- Sage Dental of Tucker
4280 Lavista Rd Ste C117
Tucker, GA 30084 - Phone
- (678) 688-4811
- NPI assigned
- Aug 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN123392 | GA | Primary |
Addresses
Primary practice location
Sage Dental of Tucker
4280 Lavista Rd Ste C117
Tucker, GA 30084
Mailing address
Sage Dental of Tucker
4280 Lavista Rd Ste C117
Tucker, GA 30084
Phone (678) 688-4811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN123392 | GA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1902352149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SAGE DENTAL OF TUCKER",
"address_2": "4280 LAVISTA RD STE C117",
"city": "TUCKER",
"state": "GA",
"postal_code": "30084",
"telephone_number": "678-688-4811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SAGE DENTAL OF TUCKER",
"address_2": "4280 LAVISTA RD STE C117",
"city": "TUCKER",
"state": "GA",
"postal_code": "30084",
"telephone_number": "678-688-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESUT",
"first_name": "CHRISTOPHER",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-28",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "GA",
"license": "DN123392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.